A surgical approach to the problem of severe lateral instability at the ankle.

A unified approach to ligamentous instability of the lateral side of the ankle was investigated in 100 ankles of 81 patients (age range, ten to 59 years). The approach consisted of augmentation of the collateral ligament system by means of the anterior portion of the peroneus brevis passed forward through the fibula and secured to the talocalcaneal interosseous ligament. In addition, torn ligaments were repaired or tightened in some cases. One hundred seven operations were performed between 1977 and 1983. Ninety-seven ankles were restored to clinical stability; 83 ankles were essentially asymptomatic. All three ankles that did not ultimately stabilize were in adolescent girls with chronic instability, one of whom was treated by three procedures. Of the remaining five repeat procedures, four had been adolescent girls initially treated for chronic ankle instability.